Request a Rural/Coastal Home Insurance Quote from JMP Insurance Brokers

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Please complete the following digital worksheet to request a Rural/Coastal Home Insurance quote.

As you'll notice, certain fields are marked with a Red (*) asterisk indicating that those fields are required. If you find that you don't know/are unsure of the answer or would rather not provide the information for a required asterisked field, please input a series of "9's" and the system should let you bypass.

Near the end of the form, you are given the option to upload any additional documents you feel are relevant to your quote request. Supported File Types are PDF/JPG/GIF/TIFF/Word/Excel/PPT/TXT, with a combined document size limit of 10 MB.

When you've finished completing the form, simply click on one of the Blue "Submit" buttons at the top and bottom of the form, and your data will be encrypted and then submitted to JMP Insurance Brokers for quoting.

Should you have any questions or would like additional assistance in completing the form, please email us at info@jmpinsure.com, or call +1-646-699-5990.

(Often required for Liability/Umbrella Coverage, even when a vehicle is not being insured) - Please include the State of Issue, License Number, Expiration Date, and Restrictions on Driving (If Any.)

Profession*

Industry Function*

Name of Employer*

Does your employer provide a group excess liability program as part of its benefits plan?*

Yes

No

Are you living with a spouse (married/engaged) of significant other?*

Second Named Insured to be Listed on the Policy

While there is no additional premium for including another party as a named-insured on this policy, the benefit is that then both parties will be covered for worldwide liability purposes if either of them is ever a named-defendant in a personal lawsuit anywhere in the world.

Second Named Insured*

FirstLast

Date of Birth*

Date Format: MM slash DD slash YYYY

Mobile Phone Number*

Please verify that this is a mobile phone number.*

Secondary Phone Number*

Secondary Phone Number Type*

Primary/Preferred Email Address*

Do you have a secondary email?*

Yes

No

Secondary/Backup Email Address

How would you prefer to be contacted?*

Email, Phone or Mail

What hours are preferred for JMP Insurance Brokers to contact you?*

Will you enter a SSN?*

Not having a SSN can affect your rate.

Yes

No

SSN*

For verification purposes, please re-enter your SSN.*

Driver's License Info*

(Often required for Liability/Umbrella Coverage, even when a vehicle is not being insured) - Please include the State of Issue, License Number, Expiration Date, and Restrictions on Driving (If Any.)

Profession*

Industry Function*

Name of Employer*

Does your employer provide a group excess liability program as part of its benefits plan?*

Yes

No

Upon clicking "Next", the data you entered is encrypted and securely transmitted to the next step of the form.

Upon clicking "Next", the data you entered is encrypted and securely transmitted to the next step of the form.

Liability & Deductible

What Liability Limit would you like?*

$500,000

$1,000,000

$2,000,000

$3,000,000

$4,000,000

$5,000,000

$10,000,000

What Deductible Level would you like?*

IMPORTANT NOTE : Some carriers we represent require a minimum policy deductible of $2,500 or higher for certain types of properties. Some policies have a separate wind/hall and/or earthquake deductibles.

$500

$1000

$2500

$5000

$10,000

Other

Automobile Insurance

Combining your Home and Auto Insurance coverages can save you up to 10% a year on both your home & auto policies.

Do you own a car?*

Would you like to receive a quote for the car as well?*

Year, make and model for each care to be insured*

17-Digit Vehicle Identification Number (VIN) for each car to be insured*

JMP INSURANCEBROKERS

• INDEPENDENT & WHOLLY-OWNED AGENCY OF JMP RISK MANAGEMENT PARTNERS, LLC • PROUD MEMBER OF THE HUDSON VALLEY AGENCY ALLIANCE (HVAA) • Proudly appointed by or representing an expanding portfolio of top-rated well-known & respected global, national, regional & specialty insurance carriers. Includes both "Admitted" & "Non-Admitted" insurance companies in the State of New York. Admitted carriers are approved to conduct business in NY State by the NY State Department of Financial Services and are backed by the NYS Insolvency Fund in the event of a carrier default. "JMPIS is authorized to issue "non-admitted "Excess and Surplus (E&S) line carriers in New York with 100% compliance with all state underwriting requirements and disclosures. Customers buying E&S policies must pay the coverage-term policy premium in-full with additional non-refundable state-required fees & taxes (including clearing hold times by different banks) after underwriting approval is received but before issuance can occur. E&S policies include substantial non-refundable cancellation penalties. Please refer to your non-admitted, E&S policy document for full-terms of all policy coverages, limitations, exclusions, account terms, etc. JMP Insurance Brokers is providing this information as a courtesy and is not responsible for its accuracy or if any information has been omitted. For complete terms and conditions, please either review your policy documents or contact your insurance carrier directly. JMP Insurance Brokers is an insurance brokerage providing insurance solutions to its customers but is neither the underwriter or claims adjuster for any of the carriers with which its appointed or represents. All underwriting and claims settlement decisions are the sole and full responsibility of each respective carrier represented by JMP Insurance Brokers. JMP Insurance Brokers bears no responsibility for customer-perceived errors/grievances/omissions disputes pertaining to any/all insurance carrier underwriting or claims decisions. As an insurance brokerage, JMP Insurance Brokers operates as an Agent of the carriers it represents in compliance of its Agency appointment with full-transparency and compliance and without prejudice or preference. JMP Insurance Brokers also operates as an Insurance Broker for its customers, prospects and business partners capable of delivering a broad range of insurance solutions with full transparency and without prejudice/preference. For complete policy terms and conditions, please refer to your policy documents or contact your insurance carrier. JMP Insurance Brokers bears no responsibility or liability for any carrier errors, discrepancies or omissions (accidental or otherwise) and are the sole responsibility of each of the respective insurance carriers represented by our agency.

Please note that coverage cannot be bound, altered or deleted via the voicemail system, SMS message or social media/third party messaging application. To request that coverage be bound, altered or deleted, the instruction must be submitted in writing via email to either jay.persi@jmpinsure.com or info@jmpinsure.com ; JMP Insurance Brokers website message using the “Contact Us” or “Contact JMP Insurance Brokers” buttons located on every page of the website; Scanned email/eFax (212.519.7908); or Regular or Overnight mail sent to JMP Insurance Brokers, Attn: Jay M. Persi, 116 West 23rd Street, Suite 500, New York, NY 10011, Main: 646.699.5990.